Some EMTs and state lawmakers believe the change could make it easier for Indiana's EMTs to find work in other states and better equip them to treat patients. But they say challenges in transitioning to the advanced rank will mean some technicians won't be able to use all of the skills they've been practicing for decades.

The new Advanced EMT level called for under a state law passed in 2012 aligns Indiana with national standards and eliminates a Basic-Advanced EMT level that's unique to the state. That law set a June 30 deadline for affected EMTs to enroll in a transition course.

Medical responders who pass the course can give patients certain medications, including a drug to treat heroin and certain prescription drug overdoses.

EMTs who fail the transition course or don't enroll in it by the deadline would drop to a basic certification level. That would mean they could no longer give intravenous drips, read heart rhythms with an electrocardiogram or give manual defibrillation to revive a patient, although they can use similarly effective devices.

Indiana EMS Commission member Lee Turpen said EMTs' use of those tactics hasn't been shown to drastically improve patient care.

Those looking to move up from the Basic-Advanced level can enroll in a bridge course to learn the new skills before July, but the cost of the course and its low passing rate could mean many will drop to a lower level.

Some EMTs "financially couldn't cut it right now," said Clinton County EMS Director Robbie Balcezak.

Certification includes shelling out about $100 for a textbook, $100 for the test and varying costs for the class that Turpen said can be as much as $1,500, as well as 100 required classroom hours for the transition course.

Other EMTS wanted to take the class but couldn't find one offered nearby, Balcezak said.

"They are going to miss out because of the deadline," he said.

On top of that, only slightly more than half of students pass the test without retaking it.

About 55 percent of students who took the advanced test passed the first time, according to the National Registry of EMTs.

That group's executive director, Severo Rodriguez, said lower scores are normal with new tests, but he also said Indiana's scores are below the national average of 60 percent. The passing rate for Indiana was 46 percent in October 2013.

Elizabeth Fiato, the chief of the Indiana Department of Homeland Security's EMS Training Section, said in an October report to the state EMS Commission that Indiana is "pretty much guaranteeing that these AEMT candidates will have to take this exam more than once."

"Please consider whether it is fair or conscionable to have these candidates dole out a quarter or more of their usable wages for an exam with such poor odds of passing," Fiato said in that report.

State EMS Commission member Myron Mackey said another part of the problem is that a rushed deadline led to changes to the training curriculum after it was released, which frustrated instructors.

"In 2012, we still didn't even know what was going to be in the new advanced curriculum," Mackey said. "We knew some of it, but we couldn't roll it out to training institutions and get it going."

State Sen. Ryan Mishler, R- Bremen, said no one raised concerns about the deadline when the legislation first was discussed in the Legislature, and only one person later wrote him about issues receiving the new certification.

No extensions in the law were made during this year's legislative session, but Turpen said members of the commission are checking to see if there's a way to delay the deadline for another year.

"They pulled the trigger with all these certification levels," said Nate Metz, director of EMS at Prompt Ambulance Central in Lafayette. "I don't think all the kinks were necessarily worked out yet."

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